Indiana's Children's Health Insurance Program (ICHIP) has enormous potential benefit for Children with Special Health Care Needs (CSHCN) who are uninsured. Indiana opted for a combination of a Medicaid managed care expansion (Phase I) and a separate State Insurance Program (Phase II). Phase I of ICHIP expands Medicaid coverage for children birth to age 18 up to 150 percent FPL. Phase II, effective January 1, 2000, serves children 150-200 percent FPL with a basic plan that includes primary, preventive and acute care. Additional services, not provided under the State Insurance Program, will be accessed through other resources for CSHCN, such as the First Steps Early Intervention (IDEA, Part C) and Children's Special Health Care Services (CSHCS, Title V). Little is known about the impact of differing health care delivery systems on children with special health care needs (CSHCN). We will assess enrollee impact for CSHCN, using a 2 X 2 quasi-experimental design. Indicators of access and quality of care will be compared within and between health care delivery systems: Phase I (comprehensive package of services), Phase II (relying on "wrap around" services from other state programs), Risk-Based Managed Care (RBMC) and Primary Care Case Management(PCCM). Specific Aims are to: 1) Describe the structural, organizational and implementation features of Phase I and Phase II of CHIP that facilitate coordination and collaboration of services for optimal outcomes of CSHCN. 2) Evaluate, within and between, program comparisons of outcomes for CSHCN including: (1) access to care; (2) utilization of services; (3) quality of care; (4) satisfaction with care; (5) expenditures for care, evidence of "crowd out"; (6) health outcomes; and (7) family impact by comparing: pre- and post- enrollment outcomes for CSHCN; CSHCN who receive services through the managed care model of RBMC to those enrolled in PCCM; and CSHCN enrolled in a comprehensive package of benefits under EPSDT (Phase I) to CSHCN with a basic service plan and "wrap-around" services (Phase II).